DigiTOP - Revenue Integrity Manager

Revenue Integrity Manager

Primary responsibility of a Revenue Integrity Manager is to ensure accurate billing, compliance, and revenue optimization. Here are the key aspects of a Revenue Integrity Manager's job description:

Responsibilities:

- Ensuring accurate billing and compliance with regulations/payor contracts/hospital tariffs

- Reviewing systems and processes to identify compliance issues.

- Collaborating with different departments, physicians and insurance companies to provide price estimations for various medical procedures.

- Providing guidance on appropriate billing practices and medical procedure coding guidelines.

- Conducting training related to billing processes and compliance.

- Analyzing existing revenue cycle processes and recommending improvements.

- Setting up procedures compliantly for hospital and physician charges.

- Preventing revenue leakage through effective processes, controls and audits.

- Review assignment of codes to medical procedures and diagnoses.

- Ensuring correct code sequencing per regulations, coding guidelines and policies.

- Verifying and clarifying information from physicians, patients and auditors.

- Collecting data for and presenting monthly reporting to Finance Head.

- Support with system enhancements to optimize revenue cycle management.

Qualifications/Skill Sets/Experience:

- Certified Professional Coder (CPC) certification required, with excellent coding proficiency in CPT- , HCPCS Level II & ICD-10-CM

- Understanding of EDI file formats (?)

- Bachelor's/Master's degree in healthcare administration, finance, or related field.

- Experience in healthcare finance, compliance, or revenue management.

- Knowledge of coding guidelines and documentation requirements.

- Experience in US Healthcare Revenue Cycle Management processes would be an added advantage

- Strong Communication skills

- Minimum 5 years of experience after CPC certification